On Tuesday, July 7, the Centers for Disease Control and Prevention released a Vital Signs report detailing the increase in use and abuse of heroin in the United States between 2002 and 2013, along with an analysis of the risk factors associated with heroin use and abuse. The CDC reports that the rate of past-year heroin use and the rate of heroin-related drug overdose deaths have both increased dramatically during this time period. Further, opioid prescription volumes are contributing to this crisis as these increases are closely linked to non-medical use and abuse of prescription opioid pain relievers.
The study relies on data from the National Survey on Drug Use and Health (NSDUH) reported between 2002 and 2013 and broken into four three-year periods. To analyze patterns of use within the data, researchers used a multivariable regression model to identify risk factors among heroin users.
The CDC’s findings provide valuable guidance for public health officials, law enforcement, policymakers and others who are engaged in the fight against America’s opioid epidemic.
Overall, the researchers found that the average rate of past-year heroin use has grown 63% over the time period studied; the average rate was 1.6 per 1,000 people aged 12 and over in 2002-04 and grew to 2.6 per 1,000 in 2011-13. During each time period studied, the rate of use for men was found to be higher than for women. Despite differences found between groups, nearly all demographic groups studied showed an increase in heroin use rates between 2002-04 and 2011-13.
One major finding was the link between past-year use of other drugs and past-year heroin use. Fully 96% of past-year heroin users reported using at least one other drug, and 61% of users reported using at least three other drugs. This suggests that heroin use is not an isolated occurrence, but instead is part of a broader pattern of drug use.
Additionally, the study found that heroin use is highly correlated with the use of specific drugs. For instance, the rate of past-year heroin use among cocaine users was a shocking 91.5 per 1,000 people. While this represents the highest rate among drugs studied, the largest percent increase during the period studied occurred for non-medical users of prescription opioid pain relievers. That rate climbed 138% from 17.8 to 42.4 per 1,000 persons.
A particularly grim finding showed that the rate of heroin-related drug overdose deaths nearly quadrupled between 2002-06 and 2011-13, from 0.7 to 2.7 per 1,000 persons.
Lastly, the regression model found that the following characteristics are associated with higher odds of past-year heroin abuse or dependence: male, aged 18-25, non-Hispanic white, resident in a large urban area, annual household income < $20,000, having no health insurance or having Medicaid and past-year abuse of or dependence on alcohol, marijuana, cocaine or opioid pain relievers.
The full study and its results can be found here.
In the conclusion to their report, CDC researchers noted a number of particularly important findings that will help guide the response to this problem in the future.
First, the greatest increase in heroin use occurred among groups with historically lower rates of use – the rate doubled for women and more than doubled for non-Hispanic whites, demonstrating that this problem is affecting people of all demographic groups.
Next, researchers noted that the problem of heroin abuse and dependence is not occurring in isolation. Past-year abuse of or dependence on alcohol, marijuana, cocaine or opioid pain relievers is a significant risk factor for heroin abuse or dependence.
Lastly, the report identifies the increased availability and lower price of heroin in the United States as a potential contributor to rising rates of heroin use.
All of these findings point to the need for a comprehensive response targeting a wider range of demographic groups and addressing the key risk factors for heroin use.
For one, a special focus on reducing opioid abuse is needed, given the strong link between opioid and heroin use and abuse. Data from Definitive Healthcare shows that physicians wrote nearly 30 million prescriptions for opioid pain relievers in 2013 as part of the Medicare Part D drug coverage program. Though the Medicare data is not fully representative of the larger prescription drug market, these 30 million prescriptions – at a cost of $2.2 billion – highlight the proliferation of opioids in the United States.
The CDC report also calls for expanded overdose recognition and response training along with broader access to naloxone to reverse opioid overdoses.
The increased use of heroin, along with abuse of opioid pain relievers, represents a public health threat for many areas of the United States. There is a clear need for public health officials, physicians and law enforcement to come together to develop a robust response to America’s opioid epidemic.
Definitive Healthcare has the most up-to-date, comprehensive and integrated data on hospitals, physicians and other healthcare providers. Our databases include Medicare’s Part D prescription drug data, allowing users to search by drug class, name and manufacturer as well as by prescribing physician criteria.